Geriatric medicine curriculum standards: Knowledge guide 9: Perioperative assessment and management

Advanced Trainees will describe the principles of the foundational sciences.

Advanced Trainees will assess patients’ current conditions and plan the next steps.

Advanced Trainees will know how to monitor patients and manage these aspects postoperatively.

Advanced Trainees will identify important specialty-specific issues and the impact of these on diagnosis and management.

Age-related decline in physiological reserve
Functional decline of the cardiovascular, respiratory, kidney, central nervous, haematological / immunological, and musculoskeletal systems
Increased risk of mortality and morbidity after elective and (especially) emergency surgery
Indications for common surgical procedures
Knowledge about risk stratification and interpretation of risk scores for frail older people
Pathophysiological changes with ageing
Risk factors for postoperative adverse outcomes and their importance

Advance care planning
Capacity to give informed consent
Clinical predictors of increased risk of perioperative cardiovascular events
Comprehensive pre-operative assessment (acute and elective)
- cognitive or functional impairment
- cognitive status
- complex comorbidities
- fall risk
- frailty
- functional capacity
- high-risk medications, e.g. anticoagulants, insulin, immunosuppressants
- level of nutrition
- medication review and assessment, including medications to be discontinued perioperatively, or modified dosage
- medications with high risk of withdrawal syndromes, including alcohol or opioids
- obesity and/or malnutrition
- pain history
- previous anaesthetic experience and complications
- routine blood work
Delirium prevention and assessment
Identification and optimisation of modifiable risk factors, improving the likelihood of a successful surgical outcome
Identify patients who would benefit from prehabilitation and rehabilitation
Principles of anaesthetic care
Procedural urgency
Shared decision-making processes and support, including risks and benefits of surgical and non-surgical management
The potential outcomes and consequences of surgery on patient function due to the physiological vulnerability of older people

Acute medical problems and postoperative complication management in liaison with surgical teams, other medical teams, nursing staff, and allied health staff
Appropriately alter medication regimens and manage fluids with the aim of decreasing risk of perioperative adverse events
Blood loss conservation, indications for transfusion
Management of constipation, urinary retention, and urinary catheters
Non-operative care
Pain management
Poor nutrition and hydration
Pre-emptive management of physiological deterioration, including hypothermia, acidosis, coagulopathy, and glycaemic control
Prevention and management of common complications
- deep vein thrombosis
- delirium
- nausea and vomiting
- postoperative cognitive dysfunction (POCD)
- sepsis
Rehabilitation post-surgery

Assessment and management of non-operative patients
Importance of living well, prehabilitation, fall prevention, and breathing exercises
Multidisciplinary collaboration, including discharge planning
Palliative and supportive care, including spiritual support
Perioperative care of fractured neck of femur
Shared decision making, including goals of surgery